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The Trouble With Things These DaysThe relationship between childhood trauma, family violence and bullying

By Leslie Ten Broeck, LCSW

“The trouble with things these days is, you’re not ALLOWED to keep your family under control. You can’t hit your wife or kids anymore, or you’ll go to jail.” The father sat in front of me, distraught, as I tried to wrap my brain around the words he’d just spoken. The KidsPeace Psychiatric Hospital had just admitted his fourteen-year-old son after an assault on a teacher, an assault that resulted in arrest and legal charges. The boy had been hospitalized the evening before, and this was the first meeting between the family and me, the clinician. The boy’s mother sat next to her husband, nodding sadly. “Could you repeat what you just said?” I asked the father. He looked uncomfortable as he answered, “Well, what I meant was, what am I supposed to do? I’m trying to keep my family in line, and these kids just do whatever they want. Now look what’s happened.” I took a deep breath and tried to look beyond the father’s words (far beyond.) Here was a father who did truly love his family, who wanted them to do the right things. He was feeling helpless and out-of-control like most parents of a child admitted to a psychiatric hospital. Yet, there was much that was different about this family … or so I thought.

It wasn’t until later meetings with the family that I learned the whole story. This was a family in which there had been significant physical abuse and domestic violence, so much so that there had been an open Child Protective Service case for a number of years. The parents, fearful of losing their children, had complied with the steps outlined by the Caseworkers and had eliminated physical violence from the home. CPS closed the case with some satisfaction, believing their mission had been accomplished. Indeed, it had; they’d succeeded in making the family one in which the children were safe. But what then? What kind of legacy would years of physical, verbal and emotional violence leave for this family? The answer was becoming clear. Their son, the oldest child, was in constant altercations in the schoolyard and was known as a bully. He had been suspended frequently. The parents were starting to suspect that he’d been using drugs and alcohol. Their daughter, age eleven, was in therapy with a history of depression and truancy—she refused to go to school. What was happening with these kids?

This family was acting out the very reality that investigators and researchers into child maltreatment know to be true: Certain forms of victimization, such as family violence, create vulnerability for bullying, perpetration or victimization. This is known as trauma reenactment. For instance, some youth who are maltreated by their families might learn that violence is the way to deal with interpersonal difficulties, and therefore physically bully their peers at school(1). In one study, 700 fifth grade students were interviewed and asked about their experience of bullying:• 14% reported that they had bullied others• 12% reported that they were the victims of bullying• 8% stated that they’d been both bullies and the victims of bullying• 66% stated that they were not involved in bullying.When the same respondents were asked about their history of maltreatment, this is what the researchers found:

• Children who were both bullies and victims of bullying reported the most child maltreatment (44%), which included experiences with physical and psychological abuse and neglect.

• Bully-victims also reported the highest rates of sexual victimization (32%), which included experiences with sexual harassment as well as sexual abuse, and included familial and non-familial perpetrators.

In addition, studies have shown that maltreated children are at least twenty-five percent more likely to experience problems such as delinquency, teen pregnancy and low academic achievement(3). Bullies who have been identified by age eight are six times more likely than others to be convicted of a crime by the time they reach the age of twenty-four. They are five times more likely to end up with serious criminal records by age thirty(4). Things were looking grim for this family, if the statistics held true. But I was more confused by the dichotomy in front of me. Clearly, these parents loved their family and wanted the best for each other. How could that fit with a history of physically harming each other?

One answer to that question comes from the Centers for Disease Control and Prevention (CDC). In 1995, the CDC collaborated with Kaiser Permanente's Health Appraisal Clinic in San Diego on a groundbreaking study called the ACE Study (http://www.acestudy.org/.) Co-principal investigators Robert F. Anda MD and Vincent J. Felitti MD conducted perhaps the largest scientific research study to analyze the relationship between multiple categories of trauma, or adverse childhood experiences, and health and behavioral outcomes later in life. More than 17,000 white, middle-class, college-educated adults were asked about their history of adverse childhood experiences (ACE’s) such as physical and emotional abuse, physical and emotional neglect, sexual abuse, substance abuse in the home, domestic violence, incarceration of an adult, untreated mental illness. Almost two-thirds of the study participants reported at least one adverse childhood experience, and more than one in five reported three or more. Clearly, the experience of childhood trauma is not an exception to the rule. The short- and long-term outcomes of these childhood exposures include a multitude of health and social problems, as follows.

The ACE Score is used to assess the total amount of stress during childhood and its life-long impact; the study demonstrated that as the level of stress increases, the risk for the following health problems increases in a strong and graded fashion:

The evidence clearly suggests that the more adverse childhood experiences (childhood traumas) that people experience, the more likely they are to have a number of problems, such as domestic violence, substance abuse, and depression. But what about the role of “traumatic reenactment?” Why would someone play out the same terrible experiences throughout their lives? Here’s what I learned:

Re-enactment of victimization is a major cause of violence. Many traumatized people expose themselves, seemingly compulsively, to situations reminiscent of the original trauma. These behavioral reenactments are rarely consciously understood to be related to earlier life experiences. Some traumatized people remain preoccupied with the trauma at the expense of other life experiences and continue to re-create it in some form for themselves or for others. War veterans may enlist as mercenaries, victims of incest may become prostitutes, and victims of childhood physical abuse seemingly provoke subsequent abuse in foster families or become self-mutilators. Still others identify with the aggressor and do to others what was done to them. These behavioral reenactments are rarely consciously understood to be related to earlier life experiences(5).

So how do we help families understand the impact of violence, trauma, and traumatic reenactment? It starts with education; families need to be provided with what is called “psychoeducation.” Our first step in working with this family was to help them understand the interactions among childhood trauma, parenting, child maltreatment, and children’s behavior. They needed to learn about the long-term patterns of violence that occur from one generation to the next, and how to stop the cycle. We encouraged the parents to talk to their children about the role that violence plays in their family; we asked them to allow the children to ask questions, even ones that made the parents uncomfortable. They needed to allow respectful dialogue, even when the subject was painful. The parents were taught to set clear limits on unsafe physical, emotional and verbal behavior within the family and as the family interacts with the community. Next, the family needed to learn the skills of managing their emotions when interacting among themselves and others; they developed and practiced these skills in the home. With the help of a family-based team of counselors, they learned techniques for managing anger; they developed safety plans for times when emotion threatened to lead to unsafe behavior; they developed communication skills, conflict resolution skills and problem-solving abilities. They worked with a number of providers to create a sense of community within their family, where everyone felt a sense of belonging and safety.

Family members were encouraged to visit ParentCentral.Net to share their experiences and receive advice anonymously from Master’s and doctorate level clinicians. There is a tremendous amount of reading material on this site, as well as a community that supports its members. Teens can visit TeenCentral.Net to discuss their thoughts and feelings after discharge and to read stories by celebrities and peers about how they overcame issues while they were growing up. Advice is also given by Master’s or doctorate level counselors within 24 hours. KidsPeace offers these two websites free of charge to all parents and teens who use their services.

Just as this courageous family did, all families who are struggling can and should seek professional services to help them take these steps. Every family has the ability to become a place where all members can seek shelter from the stressors and pressure of the outside world. Every family has the ability to make their home, instead of a place of fear and violence, a place of sanctuary.To